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Appendix C Schedule for Immunization of Preterm Infants

Jill E. Baley

ALL PRETERM INFANTS

	•	Vaccine doses should not be reduced for preterm infants.
	•	Use thimerosal-free vaccines.
	•	Intramuscular injections to preterm infants might require a shorter needle than the standard 5/8- to 1-inch needle.
	•	Live virus vaccines should never be given during hospitalization.
	•	Immunizations may be given during corticosteroid administration.
	•	Palivizumab (Synagis) should be given according to the respiratory syncytial virus (RSV) policy.
	•	Preterm infants should receive a full dose of diphtheria and tetanus toxoids and acellular pertussis (DTaP), Haemophilus influenzae type B (Hib) conjugate, inactivated poliovirus (IPV), and pneumococcal conjugate (PC7) at 60 days’ chronologic age, regardless of birthweight and gestational age.
	•	Preterm infants should be medically stable and consistently gaining weight.
	•	Immunizations for preterm infants may be given over 2 or 3 days to minimize the number of injections at a single time.
	•	Hospitalized infants with birthweights lower than 1000 g should be observed for apnea for 72 hours after the primary series of immunizations.
	•	Breast feeding by a mother who is positive for hepatitis B surface antigen (HBsAg) poses no additional risk for acquisition of hepatitis B virus (HBV) infection by the infant.
	•	Infants with chronic respiratory tract disease should receive the influenza immunization annually, before or during the influenza season, once they are 6 months postnatal age or older:
	•	The infant should receive 2 doses of vaccine, 1 month apart.
	•	Family and other caregivers should also receive influenza vaccine annually in the fall to protect the infant from exposure.

PRETERM INFANTS WITH BIRTHWEIGHTS OF 2000 GRAMS OR MORE

	•	If mother is HBsAg positive: • Administer hepatitis B vaccine and hepatitis B immune globulin (HBIG) within 12 hours of birth. • Immunize with 3 doses at 0, 1, and 6 months’ chronologic age. • Check antibody to hepatitis B surface antigen (anti-HBs) and HBsAg at 9 to 15 months of age. • If infant is anti-HBs and HBsAg negative, reimmunize with 3 doses at 2-month intervals and retest.
	•	If mother is HBsAg unknown: • Administer HBV by 12 hours of age. • If the mother tests positive, give HBIG within 7 days of birth and proceed as for HBsAg-positive mother.
	•	If mother is HBsAg negative: • Administering HBV vaccine at birth is preferable to waiting for the first pediatric visit. • Immunize with 3 doses at 0 to 2, 1 to 4, and 6 to 18 months of chronologic age. • Follow-up anti-HBs and HBsAg titers are not needed.

PRETERM INFANTS WITH BIRTHWEIGHTS LESS THAN 2000 GRAMS

	•	If mother is HBsAg positive: • Administer HBV and HBIG within 12 hours of age. • Immunize with 4 vaccine doses at 0, 1, 2 to 3, and 6 to 7 months’ chronologic age. • Check anti-HBs and HBsAg at 9 to 15 months of age. • If anti-HBs and HBsAg are negative, reimmunize with 3 doses of vaccine at 2-month intervals and retest titers.
	•	If mother is HBsAg unknown: • Administer both HBV and HBIG by 12 hours of age, as HBV is less reliable as a single agent under these conditions. • Test the mother immediately.
	•	If mother is HBsAg negative: • Administer the first dose of HBV at 30 days’ chronologic age regardless of gestational age, or at discharge if the infant is discharged before 30 days of age. The infant must be medically stable and consistently gaining weight before receiving the vaccine. • Immunize with 3 doses at 1 to 2, 2 to 4, and 6 to 18 months’ chronologic age • HBV-containing combination vaccine may be given after 6 to 8 weeks’ chronologic age. • Follow-up titers are not needed.